Background:
Although one fourth of Medicare dollars are spent during the last year of life, more than half of terminal hospitalized patients have inadequate symptom control. End‐of‐life care in hospitals is associated with uncomfortable physicians, high cost, and poor symptom control. Hospitalists are strategically positioned to address this issue, both through patient care and resident teaching. We introduced a palliative care order set and measured the effect on resident physician comfort, prescription of palliative medications, and hospital charges.
Methods:
An inpatient palliative care order set was created by an expert panel and released with an educational E‐mail to 144 internal medicine residents at a large academic medical center. The order set discontinued all nonpalliative care measures and addressed many aspects of symptom management. Residents were surveyed before and after about their comfort with palliative care. An observational study was performed looking at patients who died in the hospital to compare those who had an order set used (n = 27) and those who did not (n = 42). Resident comfort, patient charges, and prescription of palliative care medications were compared and analyzed using t tests.
Results:
Three months after the order set was released, 88% of residents were using it, and 63% believed it had increased their comfort with palliative care. Use of this order set resulted in the number of first‐year residents comfortable with palliative symptom management increasing from 40% to 65% (P < .0001), which significantly surpassed the 48% of second‐year residents who reported being comfortable (P = .02). The prescribing of palliative care medications was significantly increased by the order set in all therapeutic categories. Hospital charges during the last day of life for patients using the order set were 85% less than those for whom the order set was not used (P = .01), and charges per day decreased by 52% in the days after the order set was used compared with the days before its use (P = .0001).
Conclusions:
Introducing a palliative care order set improved resident comfort with palliative symptom management and increased the prescribing of palliative medications in terminal hospitalized patients. Hospital charges were reduced in patients who decided to have palliative care only, and the charge per day was reduced after the order set was started. This shows order sets can be used as quality improvement tools to assist in education, standardize patient care, and reduce hospital charges in certain situations such as palliative care.
Author Disclosure:
B. Jarabek, none; A. Jama, none; S. Cha, none; S. Ruegg, none; T. Moynihan, none; F. McDonald, none.